Improving Sleep After Traumatic Brain Injury

A traumatic brain injury (TBI) is a sudden jolt to your head that changes how your brain works. A TBI can happen from:

• A blow to your head

• A blast

• Sudden movement of your head that causes your brain to move inside your skull

• Bullet or fragment going into your brain

• A fall

• A fight or combat

• Sports injury

• Car accident

TBI is more common in men than women. It is also more likely to occur in those younger than age 25. 

TBI can cause many brain changes. Everybody’s brain is different. So your symptoms may be different from those of others. Symptoms can include changes in the way you feel, act, think, and move. Trouble sleeping is a symptom that affects many people with TBI. About 6 in 10 people with TBI have this problem.

Why TBI causes sleep problems 

Having a TBI may cause a sleep problem for many reasons. These include:

• Direct injury to the sleep areas in the brain

• Changes in melatonin, a brain hormone that helps regulate sleep

• Other injury types

Other problems and some common TBI symptoms can also make it harder to sleep. These include:

• Abuse of drugs and alcohol

• Mental health problems, such as depression and anxiety

• Daytime sleepiness (because you may end up napping during the day)

• Headache and other types of pain

Types of sleep problems with TBI

If you are recovering from TBI, you may:

• Have trouble falling asleep or staying asleep (insomnia)

• Wake up often and easily (you’re a “light sleeper”)

• Not be able to fall back asleep

• Have trouble getting enough oxygen while sleeping (called sleep apnea)

• Fall asleep suddenly without any control (narcolepsy)

• Walk or move while asleep with no awareness of this (sleepwalking) 

Why sleep is important for TBI recovery 

Your brain needs sleep to heal from a TBI. Not getting enough sleep can make many other TBI symptoms worse. These symptoms include:

• Severe tiredness (fatigue)

• Confusion

• Pain

• Depression

• Anxiety

• Mood swings

• Memory problems 

Help for TBI sleep problems

Insomnia after TBI can last a while. It may occur with depression. You may also have trouble doing daily activities. If your symptoms get worse or last for more than a few weeks, contact your healthcare provider. They may advise:

• A kind of talk therapy called behavioral therapy

• Antidepressants

• Medicines to keep you awake during the day

In most people, medicines that help you sleep don't work for sleep problems from a TBI. Many sleep medicines, including over-the-counter ones, can make TBI worse. Don’t take any sleep medicines or aids until you talk with your provider.

The best way to treat sleep problems from a TBI is with healthy sleep habits. That means:

• Going to bed and getting up at the same time every day, including weekends

• Not having caffeine, alcohol, and nicotine

• Getting some exercise and sunshine each day. This helps reset your internal clock.

• Resting during the day. But not napping for more than 20 minutes.

• Not exercising or eating a large meal in the hours before bedtime

• Keeping your bedroom quiet, dark, and at a comfortable temperature

• Not using electronic devices like your TV or computer at least 30 minutes before bedtime

• Not lying awake in bed if you have trouble falling asleep. Instead, get up and do a relaxing activity for a short time.

Sleep problems are common after a TBI. If healthy sleep habits are not helping, talk with your provider. They may advise relaxation methods. Or you can try talk therapy if you have a mental health problem like depression or anxiety.  

Sleeping well can help your brain recover. Your provider can help you get the rest you need.